Fractional CFO Services for Physical Therapy Practices
Financial leadership for physical therapy, occupational therapy and multi-discipline therapy practices doing $1M to $10M in revenue. We help you find your real cost per visit, fill your clinicians' schedules profitably, plan around insurance payment delays, and pay yourself from a plan instead of whatever is left.
Talk to a CFO Who Understands Therapy Practices
We'll look at your numbers with you and show you where the money is going. Free, no obligation, no pitch.
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Does Any of This Sound Familiar?
None of that means the practice isn't working. The therapy practices we work with usually have full waitlists, loyal patients and clinicians who are great at what they do. The problem is that clinical skill and financial visibility are different jobs. A bookkeeper tells you what happened last month. Most practice owners are missing someone who looks forward: what each visit costs, how full the schedules need to be, what the next hire has to produce, and how much you can safely take home.
What Fractional CFO Services Look Like for a Therapy Practice
We meet with you twice a month as your financial partner. We get your numbers right, build the tools you need to plan, and help you make the big calls on hiring, clinician pay, payer mix and growth with real numbers in front of you.
Cost per Visit and Margin by Discipline
What a visit really costs once clinician pay, billing fees and merchant fees are counted, and which disciplines and payers carry the practice.
Clinician Capacity and Schedule Targets
A model of how many sessions each clinician can realistically see, and weekly visit targets that show when you're at break-even, building reserves, or full.
Payer Mix and Paid per Visit
Your average paid per visit by payer and discipline, how cash-pay and insurance compare, and what a change in mix does to your margin.
A Cash Forecast With Collection Lag
A forecast that accounts for insurance paying weeks after the visit, seasonality and cancellations, so payroll stops being a surprise.
Owner Pay, Taxes and Reserves
A set owner draw, money set aside for taxes, and reserve targets, so you know what's yours before you touch it.
Hiring Models Before You Hire
How many visits a week a new PT, OT or speech therapist needs to cover their pay, and how fast you can get them there.
Want to Know What a Visit Really Costs Your Practice?
Book a free call and we'll walk through your numbers together.
Book My Free Cash Flow CallCase Study: A Two-Location PT Practice Takes Margin From 43% to 54%
This owner had spent about ten years building a busy, mostly cash-pay practice with two clinics. On paper it was profitable. In practice, he was still moving money between accounts to make payroll. He paid himself a small salary and covered personal bills through the business, so there was no clear line between what the practice earned and what he took. Clinician labor was running at 49% of revenue, raise requests had no framework behind them, and he had no cost-per-visit number to plan with.
What we worked on
- Books he could trust. We cleaned up QuickBooks, moved the owner's pay out of direct costs, counted billing and merchant fees as the cost of a visit, and separated personal spending from the business.
- A fixed owner draw. Instead of running personal bills through the practice, he now pays himself a set amount every week.
- A budget with a floor and a ceiling. Monthly revenue targets for break-even with reserves (the floor) and for funding a leadership bonus pool (the ceiling), reviewed against actuals every month.
- A capacity model. Visit volume, cost per visit and clinician capacity showed that a 20% margin wasn't reachable with the current team, but about 15% was. That shaped the hiring plan.
- Pay tied to profit. A leadership bonus paid from profit above goal, so raises have a framework.
- Numbers the team understands. A finance training session for the leadership team, a business health dashboard, and a P&L for each location.
By October the practice was about $107,000 ahead of its revenue goal for the year, with September at an 18% net margin. There's still work to do: reserves aren't fully funded yet, and one location is less profitable than the other. But for the first time, the owner can see exactly where each of those stands.
"My gut has served me very well for a long time, but we're too big to rely on that anymore."
Owner, two-location physical therapy practiceCase Study: A $3M Pediatric Therapy Practice Beats Last Year's Profit in Seven Months
When this practice brought us in at the start of 2026, it had grown to over $3M without a budget, projections or a plan for owner pay. Labor was heavy, therapist schedules were running well below what they could handle, and insurance payments arrived months after the work. The owner had never taken a distribution. We covered the first 10 weeks in the full case study. Here is what happened next.
What we built
- A capacity model and weekly session targets. Color-coded bands show the break-even week, the reserve-building week and the full week, so the team knows every Monday where it stands.
- A collections forecast. Insurance payment timing and seasonality built in, so a strong month of visits isn't mistaken for a strong month of cash.
- Monthly budget vs. actual. It caught overspending early, including a recruiting ad budget that had crept up and a month with an extra payroll.
- A hiring calculator. It shows the visits per week a new therapist needs to break even, so the practice hires ahead of demand instead of in a panic.
- Owner pay and reserves. The owner's first distribution, plus separate accounts for taxes and long-term reserves.
Not every month was a win. April ran at a loss because of a third payroll and some overspending, and the monthly review showed exactly why. By July the practice had its highest revenue month of the year, and net profit for the year was already well above all of 2025.
A note on the numbers: the first case study quotes about 4% net profit for 2025, measured on cash actually collected and paid out. The margins above are from the books, where 2025 averaged about 12%. Both point the same way.
"We are efficient. We are profitable. We don't need to pack to the gills in order to get profitable."
Practice leadership, pediatric therapy practiceMore Therapy Practice Case Studies
Cash-pay PT: from guesswork to consistent owner pay
A PT owner near $500K in revenue couldn't say what he could pay himself. Now he pays himself on a schedule and hires from a model. Read the case study
Golf PT practice: financial systems for smarter growth
A niche sports PT owner went from quarterly reports he couldn't read to a monthly review he runs himself. Read the case study
Chiropractic, $1.3M: hidden profit uncovered
A thriving clinic that couldn't trust its own numbers found hidden profit and the confidence to expand. Read the case study
Dental: practices with a similar payer problem
How we help dental practices with insurance write-offs, provider pay and overhead. See dental CFO services
What We Usually Find in the First 30 Days
Clinician labor above 45% of revenue
Both practices above started near 48% to 49%. Usually it isn't overpaid clinicians. It's schedules that aren't full enough to cover what the team costs.
The cost of a visit is undercounted
Billing service fees, merchant fees and EMR costs sit in overhead, so the margin on each visit looks better than it is.
Capacity measured against the wrong number
Utilization is judged against a perfect schedule instead of one that allows for cancellations, documentation and the non-treatment work clinicians actually do.
Insurance lag nobody has modeled
Visits are strong, but the cash from them arrives a month or more later. Without that in the forecast, a growing practice feels broke.
Personal and business money mixed together
Owner bills paid through the practice, irregular draws and no tax savings, so nobody can say what the practice really earns or what the owner can take.
When Does a Physical Therapy Practice Need a Fractional CFO?
Most therapy practices start to outgrow a bookkeeper somewhere past $1M in revenue. That's usually when there are several clinicians, maybe a second discipline or location, a mix of cash-pay and insurance, and decisions too big to make from the bank balance. A full-time CFO usually doesn't make sense until well past $20M. For what changes at each stage, see fractional CFO services for $1M to $20M businesses.
A few signs it's time:
- You're profitable on paper, but cash is tight every month.
- You can't say what a visit costs or which discipline earns the most.
- You keep hiring, and net profit doesn't go up.
- You're considering another clinician, a second location or a change in payers without a forecast.
- You've never taken a planned owner distribution, or you take whatever is left.
What a Therapy Practice CFO Handles That Your Bookkeeper Can't
Clinician Pay and Productivity
Pay ladders, productivity bonuses and visit targets that reward your best clinicians without breaking your margin.
Cash-Pay vs. Insurance
What each payer really pays per visit, what moving more patients to cash-pay would do, and when a plan is worth keeping.
Memberships and Packages
Pricing memberships and visit packages so they bring in steady revenue instead of discounting your best patients.
Second Locations
A P&L for each location, so you know whether the new clinic is building the business or being carried by the first one.
Billing Company Oversight
Days to payment, underpaid claims and billing fees tracked monthly, so problems surface in weeks instead of at tax time.
Space, Equipment and Debt
Rent as a share of revenue, equipment purchases and loan payoff, planned before you sign.
What the First 90 Days Look Like
Days 1 to 30: Get the numbers right
We review your books line by line, separate personal and business spending, count the true cost of a visit, and split your P&L by location or discipline.
Days 31 to 60: Build the tools
We build your capacity model and weekly visit targets, a cash forecast with insurance lag built in, and a simple dashboard.
Days 61 to 90: Plan forward
We set owner pay, tax savings and reserve targets, model your next hire, and start twice-monthly meetings to review budget versus actual.
Therapy Practices We Help
We work with therapy and healthcare practices across the United States. Everything runs remotely through video calls, shared dashboards and access to your accounting system, so you get the same CFO partnership wherever you are. Browse all client case studies.
Free Guides for Practice Owners
- How to pay yourself as a business owner
- Should I hire another employee?
- Why you can be profitable on paper and never have cash
- How much does a fractional CFO cost?
- Podcast: hiring and keeping clinicians when reimbursement caps pay
- Free workshops on cash flow, margins and hiring
Frequently Asked Questions
A fractional CFO gives your practice part-time, senior financial leadership. For a PT or therapy practice that usually means cleaning up the books, finding your real cost per visit and margin by discipline, building a capacity model for your clinicians, forecasting cash with insurance collection lag built in, setting owner pay and reserves, and modeling hires before you make them. Most practices we work with are doing $1M to $10M in revenue.
Usually once you're past about $1M in revenue, have several clinicians, and decisions about hiring, pay, a second location or your payer mix are too big to make from the bank balance. Common signs are being profitable on paper but tight on cash, labor running well above 45% of revenue, schedules that never feel full, and no clear answer on what you can pay yourself.
For the therapy practices we work with, we aim to keep direct clinical labor, meaning treating clinicians' pay, payroll taxes and benefits, somewhere around 35% to 45% of revenue. Above that, cash gets tight fast. The right target depends on your payer mix and how much non-treatment work your clinicians do, so we often split their time between patient care and overhead.
Work out how many visits per week the new clinician needs to cover their pay, benefits and share of overhead, then how quickly you can realistically get them there. In one practice we work with, a therapist paid $100,000 breaks even at about 21 visits a week. A hiring model like that turns a gut call into a clear target for scheduling and onboarding.
Cash-pay visits are paid at the time of service and usually at a higher rate. Insurance visits are paid later, often a month or more after the visit, and the first payment offer can come in low. A practice with a large insurance share needs a cash forecast that includes that collection lag, plus a clear view of the average paid per visit by payer, or it will feel short on cash even in strong months.
Our fractional CFO services run $3,500 to $6,000 a month, plus a one-time $6,000 onboarding fee for setup. Price depends on complexity: the number of locations and disciplines, your payer mix, transaction volume, and how much cleanup the books need. That's a fraction of the $200,000 to $350,000 or more a year a full-time CFO costs.
Ready to Know What Your Practice Really Earns?
Book a free cash flow call. We'll look at your numbers together and show you what a fractional CFO would fix first.
Book My Free Cash Flow Call Or start with the free Profit Margin CheckupFree call · No sales pressure · Just an honest look at your numbers